Surgery for soft tissue sarcoma
Soft tissue sarcomas are rare, so surgery is done by a surgeon who specialises in treating them. The surgeon is part of a multidisciplinary team (MDT).
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About soft tissue sarcoma surgery
Types of surgery for soft tissue sarcoma
Wide local excision
Surgery to the chest or tummy (abdomen)
Surgery to the arms or legs (limbs)
Surgery to the head and neck
Surgery to remove sarcoma that has spread
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You may have a lump removed and only find out it is a soft tissue sarcoma after the surgery. In this situation, you will be referred to a sarcoma specialist who is part of an MDT after your initial surgery.
The aim of most sarcoma surgery is to remove all of the tumour. Usually, an operation called a wide local excision is done. This means the surgeon removes the tumour, along with an area (margin) of healthy, cancer-free tissue around it.
After the operation, the pathologist examines the tissue from the margin. If there are cancerous cells in the margin, you may need another operation to remove more tissue. Making sure the margins are clear reduces the risk of the cancer coming back.
It is difficult to give general information about sarcoma surgery, because the type of operation you have will depend on where in your body the sarcoma is. In this information, we explain the types of surgery used for people with a soft tissue sarcoma in different parts of the body.
Some types of surgery for sarcoma are minor and only involve removing a small amount of tissue. Some operations are major and may affect how that area of the body works, or how it looks.
Before surgery, you may be referred to a rehabilitation team. They will help you recover from the operation and keep as much function as possible. If the surgery is very minor, you may not need the help of the rehabilitation team.
Your surgeon and specialist nurse will discuss your operation and rehabilitation with you.
The aim of most sarcoma surgery is to remove all of the tumour. Usually, an operation called a wide local excision is done. This is when the surgeon removes the tumour, along with an area of healthy, cancer-free tissue around it. This area is called a margin.
After the operation, a specialist called a pathologist examines the tissue from the margin. If there are cancerous cells in the margin, you may need another operation to remove more tissue. Making sure the margins are clear reduces the risk of the cancer coming back.
The type of operation you have will depend on where the sarcoma is. You may have other treatments before or after surgery or both.
Surgery is usually the main treatment for soft tissue sarcomas in the chest and tummy (abdomen). This area of the body is called the trunk. The type of operation will depend on the position of the tumour. Your surgeon will discuss this with you before the operation.
If the tumour is in the tummy, it can be difficult to remove it along with an area of healthy tissue (margin). This is because the tumour may be very close to important organs, like the kidneys and liver, or main blood vessels.
You may have radiotherapy after an operation to remove a sarcoma in the chest or tummy. This is to try to make sure any remaining cancer cells are destroyed.
It is usually possible to remove a soft tissue sarcoma in an arm or leg without having to remove the whole limb. This is called limb-sparing surgery. It is often done by using a combination of surgery, radiotherapy and occasionally chemotherapy.
We have more detailed information about what to expect before and after limb-sparing surgery.
Rarely, the best treatment option is to remove the affected limb to make sure all the cancer has been removed. This is called amputation.
The type of surgery you have will depend on the exact position and size of the tumour. Your surgeon will discuss this with you before the operation.
It is important that you understand what is going to be removed and how this will affect you after the operation.
Changes to speech or swallowing
Your surgeon will do everything possible to reduce any effects surgery may have on the way you:
Sometimes there is a risk your speech, swallowing or eating could be affected for a time after surgery. In this situation you will see a:
- speech and language therapist (SLT), who will teach you exercises to help you communicate
- dietitian, who will give you advice about eating and make sure you get enough nutrition.
- They help to prepare you for surgery and continue to support you after surgery.
If the operation involves removing tissue used for speech and swallowing, or affects your appearance, you may have reconstructive surgery at the same time.
A plastic surgeon takes tissue from another part of the body, such as the forearm, thigh or chest. This is used to replace the tissue they take from the head and neck.
Depending on the size and position of the sarcoma, the surgeon may have to remove a large area of tissue. This may include important nerves and blood vessels. You may need to have surgery to reconstruct the area. This is done at the same time as your operation, usually by a plastic surgeon.
The aims of reconstructive surgery are to:
- make the area look and work as naturally as possible
- pad and protect important tissue nearby
- help the wound to heal.
The operation will depend on where in your body the sarcoma is and how much tissue the surgeon needs to remove. If it is a smaller area, the surgeon may be able to join the 2 edges together again. For larger areas, they may need to use a skin graft or tissue flap.
A skin graft is a very thin layer of skin. The surgeon takes a layer of skin from another part of the body called the donor site. They put this over the area where the cancer was.
Skin is often taken from the outer thigh. If a skin graft is needed for the face, surgeons usually take skin from behind the ear or the neck. This is done to try to get a good skin colour match.
After the operation, you normally have a dressing over the area. This presses the graft down to help create a good blood supply from the blood vessels underneath.
Sometimes, plastic surgeons need to use a specialist technique to repair the operation site. They use a slightly thicker layer of skin and tissue than for a skin graft. This is called a tissue flap. Tissue flaps include fat and muscle. The different types of tissue flap include the following:
- A local flap uses tissue from an area close to where the cancer has been removed.
- A pedicle flap uses tissue from an area further away, but close enough to keep the flap connected to its original blood supply.
- A free flap uses tissue that has been completely removed from another part of the body, along with its blood vessels.
The surgeon and specialist nurse will explain your operation and answer any questions you have.
Surgery is sometimes used to remove a sarcoma that has spread to other parts of the body or come back after treatment. An operation is usually only possible if:
- the tumours are small
- there are only a few tumours.
It is mainly done when the sarcoma has spread to the lungs. But it might be used for tumours in other parts of the body. If you need to have this operation, your doctor will talk to you about it.
Below is a sample of the sources used in our soft tissue sarcoma information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Gronchi A, Miah AB et al. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2021; 32, 11, 1348-1365 [accessed May 2022].
Casali PG, Blay JY et al. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2022; 33,1, 20-33 [accessed May 2022].
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